434416250-6-27-2023-07-CC-FRAA-CT7LPB-20230627085539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416250
Report Date: 06/23/2023
Date Signed: 06/27/2023 08:55:45 AM

Document Has Been Signed on 06/27/2023 08:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PRIMROSE SCHOOL OF EVERGREEN		FACILITY NUMBER:	434416250
ADMINISTRATOR:	GERANNY NATIVIDAD		FACILITY TYPE:	840
ADDRESS:	3008 ABORN ROAD		TELEPHONE:	(408) 440-8215
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	22	CENSUS: 17	DATE:	06/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Geranny Natividad		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Farida Raja, met with Director, Geranny Natividad, for an unannounced Required 1-Year inspection in the School Age Program. The facility is licensed to serve children ages 5-12 years in one classroom. A licensed preschool (434416248) and infant center (434416249) is present on the same premises. The facility has two waivers on file for electronic sign in/ out and shared outside playground space. LPA observed the required posted materials including Emergency Disaster Plan, Dietary Restrictions and Allergy List and daily activity schedule in the classroom. Days and hours of operation are Monday through Friday, 12:30 am to 6:30 pm and 6:30 am to 6:30 pm during school recess. At present, due to summer break, children are in attendance full-time from 6:30 am to 6:30 pm. Upon arrival LPA observed 2 teacher and 17 children which is compliant with the facility license capacity and ratio requirements. LPA and Director toured the indoor and outdoor areas of the School Age Program during today's inspection. The classroom, children's restrooms, staff restrooms, kitchen and office area were inspected. There is a working telephone in the facility (408-440-8215). During today's inspection, LPA observed children engaged in various activities and projects with staff. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. Disinfectants, cleaning products and medicines were stored inaccessible to the children in high, locked cabinets. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazards. LPA observed solid waste container with tight-fitting lid in the room. Two sinks and two toilets were observed to be safe, sanitary, and in working condition. Staff has one separate bathroom that can be utilized by sick children if needed. LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 06/14/2023 which is compliant with the six month requirement for facilities. Continued on page 2

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMROSE SCHOOL OF EVERGREEN	FACILITY NUMBER: 434416250
	VISIT DATE: 06/23/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles and water pitcher and disposable cups. Water lead testing was completed for the facility on 04/28/2023 and no Action Level Exceedances were reported. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Foods and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration are stored in covered containers at 36F or less. Director stated that the facility does not allow outside food except for infants because of food allergies and dietary restrictions. Facility allows parents to provide milk substitutes for children which are kept labelled and refrigerated. The facility provides lunch and three snacks throughout the day. The menu is in writing and posted at least one week in advance, accessible to authorized representatives. Director stated that they use the Procare app to update parents in real time regarding their child's day.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition and has sufficient resilient materials (synthetic grass) to absorb falls. Areas around and under high climbing equipment and slides were cushioned with rubber mats that absorb falls. Shaded rest area is provided by one large canopy over the play structure. Children sign in and out procedures and logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed five (5) children's and 2 staff files during today's inspection. Each child's file reviewed contained the required forms including a transportation agreement.

All staff files reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required Immunization's against Pertussis, Measles an Influenza (or an opt out statement). LPA also observed the required Mandated Reporter Training on file for all staff.

Continued on Page 3

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMROSE SCHOOL OF EVERGREEN	FACILITY NUMBER: 434416250
	VISIT DATE: 06/23/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Director stated that facility does handle medications and currently has children in care who require Incidental Medical Services. LPA observed the medication is properly stored, with the proper documentation, in the office area. Medication that requires refrigeration in stored in the lobby with proper documentation. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Facility has an approved IMS Plan on file with San Jose Regional Office. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Facility does provide transportation to school age children. LPA reminded Director that children cannot be left in parked vehicles unattended at any time, the vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Exit interview conducted and report was reviewed with the Director, Geranny Natividad.
As a result of today's inspection, there were no deficiencies cited.
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3